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Ann Trop Paediatr. 1987 Jun;7(2):91-9.

Deaths in infancy and early childhood in a well-vaccinated, rural, West African population.


A survey of deaths in children under the age of 7 years was made over a 1-year period in a rural area of The Gambia with few facilities for curative medicine but with a good record of infant immunizations. One hundred and eighty-four deaths were investigated. Only 12% of deaths occurred in a hospital or health centre but an attempt was made to establish a cause of death by interviewing the family of each dead child and by examining any health records that were available. The infant mortality rate was 142 per 1000 live births and the child mortality rate (death in children aged 1-4 years) 43 per 1000 per year. Acute respiratory infections, malaria and chronic diarrhoea with marasmus were the most frequent causes of death after the 1st month of life. Few children died of diseases that could have been prevented by routine immunizations. An effective immunization programme has probably had some effect on deaths in infancy and early childhood but it will be necessary to find ways of preventing deaths from malaria, acute respiratory infections and chronic diarrhoea/marasmus at the primary health care level if infant and childhood mortality are to be reduced further in rural areas of The Gambia.


Mortality under seven years of age in a rural population in the Gambia in 1982-1983 is analyzed. The population examined is one with a high level of infant immunization but poor access to health facilities. An infant mortality rate of 142 per 1,000 live births and a mortality rate for children aged 1-4 years of 43 per 1,000 are observed. Acute respiratory infections, malaria, and chronic diarrhea with marasmus are shown to be the major causes of death after the first month of life. The authors conclude that very little impact could be made on these rates by expanded immunization efforts.

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